Tuesday Afternoon, April 17, 1951
2:00 P.M. Executive
Session.
3:00 P.M. Scientific
Session.
Address of the President-Alfred Blalock, Baltimore, Md.
19. The
Pathogenesis of Bronchopleural Fistulas Following Excisional Therapy for
Pulmonary Tuberculosis.
G. N. Stemmermann (by
invitation), C. Daniels
(by invitation) and
O. Auerbach, New York, N. Y.
Bronchopleural fistula is one of the common
complications of exci-sional therapy for tuberculosis. If, as is often the
case, it is associated with tuberculous empyema it is a serious threat to the
patient since it serves as a source of spread to the contralateral lung.
Observations in five cases, four of which were studied in detail at necropsy,
are recorded. The possible sources of fistula are classified and discussed. The
authors feel that erosion of the bronchial stump by tuberculous empyema and
technical errors in stump closure are the major sources of fistulas. The former
occurs late in the postoperative course whereas the latter occurs early. It is
noted that late fistulas are associated with a grave prognosis. All five cases
reported herein fall into the late category.
20. Bronchiectasis:
A Comparative Study of Tuberculous and Nontuberculous Pyogenic Suppurative
Disease.
Joseph Gordon, Ray Brook, N. Y. and
Philip C. Pratt (by invitation) Saranac
Lake, N. Y.
The present treatment of chronic pulmonary tuberculosis
by surgical extirpation has afforded an opportunity for study of the
histo-pathology of the disease with renewed interest. This has naturally given
rise to discussion of the term bronchiectasis as it is associated with
pulmonary tuberculosis. It seems timely, therefore, to make a comparative study
of tuberculous and nontuberculous bronchiectasis for purposes of clarification
of terminology and for the recognition of essential differences.
It is immediately recognized that in pulmonary
tuberculosis the disease is essentially parenchymal involving all units of the
lung structure. On the other hand pyogenic nontuberculous bronchiectasis is
essentially a tubular system disease with secondary changes in the immediately
subjacent parenchyma.
This study includes (1) clinical comparison; (2)
roentgenographic comparisons showing also differences in bronchograms; (3)
studies of the injected pulmonary arterial systems as well as bronchi of
excised lungs; and (4) the variable features of the histopathology. The
pathogenic mechanisms operating in each instance are considered in an effort to
understand better their role and possible relationship to the prognosis of each
disease entity.
21. The
Prognosis of Residual Bronchiectasis After Incomplete Resection.
George P. Rose Mono, W. Emory Burnett and
Joan-Humphrey Long (by invitation), Philadelphia, Pa.
One hundred and ninety-six patients with bronchiectasis
have had pulmonary resections in Temple University Hospital from 1936 through
1949. Fifty-five patients still have residual disease. The causes for this
include: 1. Only palliation was anticipated. 2. Some patients with bilateral
disease are between procedures. 3. Error in definitely diagnosing the extent of
disease preoperatively. 4. Error in proper anatomic evaluation during
operation.
This paper discusses the condition of these patients at
the present time, one 14 years after surgery, and compares them with 104
patients who had all disease removed.
Of the 55 patients with residual disease, 14 (25%) have
no cough and no subjective symptoms; 36 (65%) have less cough; and 5 (9%) are
unimproved or worse.
Preoperative function studies have not proven to be a
reliable index of postoperative dyspnea in cases where there is residual
disease. Poor results have been generally confined to the group of patients
having residual disease.
Every precaution should be taken to remove all diseased
lung if possible. The result of removal of the most severely diseased portions
of lung in extensive bronchiectasis is not completely predictable but usually
results in worthwhile palliation.
7:00 P.M. Cocktail
Party-Chalfonte-Haddon Hall.
8:00 P.M. Banquet-Chalfonte-Haddon
Hall. Dancing.
